🏥 Testicular Torsion: UROLOGICAL EMERGENCY 🚨

🚦 The Essentials

• Testicular torsion = twisting of the spermatic cord → blood supply cut off!
• Think: “Twisting cord, blood flow ignored.”
• 💡 Most common in males 10–30 yrs (peak: 13–16), but can happen at any age (including neonates).

🧬 Why Does It Happen?

• Bell clapper deformity (testicle free to twist)
• 🧬 Family history/genetic factors
• 💥 Sudden movement, trauma, or sometimes no obvious trigger

🚩 Classic RED FLAGS

• ⚡️ Sudden, severe, one-sided testicular pain (may wake from sleep)
• 💥 Scrotal swelling & redness
• 🤢 Nausea & vomiting
• ❌ Absent cremasteric reflex (no upward movement when inner thigh stroked)
• 🔝 High-riding, horizontal testis
• History of previous similar pain? (suggests intermittent torsion!)

🩺 Key Differentials

• Epididymo-orchitis (usually older, slower onset, urinary/STI signs)
• Torsion of appendix testis (blue dot sign)
• Trauma, hernia, tumour (usually painless, gradual), hydrocele
• Mnemonic: Severe pain, swollen & red, reflex fled

📈 Epidemiology

• Incidence: ~1 in 4,000 males <25
• Peak: Adolescence
• Time = Testicle: 6hr = 90–100% salvage; >12hr = 50% or less!

🩻 Investigations

• Clinical diagnosis is KING 👑 – don’t delay!
• 🔊 Doppler ultrasound: Absence of blood flow (can help but don’t delay surgery if high suspicion)
• 🧪 Urinalysis: Rule out infection

UK/US guidelines:

If clinicalsuspicion is high, immediate surgicalexploration—do NOT wait for scan.

🔪 Management

• EMERGENCY SURGERY: Detorsion + orchidopexy (fix both sides)
• Attempt manual detorsion only if immediate surgery not available (temporary)
• Orchidectomy if testis is non-viable
• Prosthesis option later if needed
• Mnemonic: “Six-hour window, high-win ratio”

😱 Complications

• Testicular loss/atrophy (irreversible tissue death)
• Infertility/subfertility (can affect both testes via immune response)
• Recurrence if not fixed
• Psychological distress
• Infection/abscess if tissue necrosis

📝 Quick Revision Links

• Revision Notes:
  https://www.passthemsra.com/topic/testicular-torsion-revision-notes/
• Flashcards:
  https://www.passthemsra.com/topic/testicular-torsion-flashcards/
• Accordion Q&A:
  https://www.passthemsra.com/topic/testicular-torsion-accordion-qa-notes/
• Rapid Quiz:
  https://www.passthemsra.com/topic/testicular-torsion-rapid-quiz/
• Full Quiz:
  https://www.passthemsra.com/quizzes/testicular-torsion/
• More free resources:
  https://www.passthemsra.comhttps://www.freemsra.com

🔑 TAKEAWAY

• Sudden testicular pain = torsion until proven otherwise!
• ACT FAST: Every minute counts for testicular survival & fertility!
• 🚑 If in doubt, get help—no delay!

#MSRA#TesticularTorsion #Urology #Emergency #MSRARevision #Surgery #SaveTheTesticle 🚨🍳🩺